Navigation Procedures Research Articles

Assessment of needle-based confocal laser endomicroscopy (nCLE) as a tool for real-time diagnosis of non-small cell lung cancer.

The widespread deployment of screening programs has increased the number of suspected pulmonary nodules diagnosed. The main objective of this retrospective study was to evaluate the concordance between needle-based confocal laser endomicroscopy (nCLE) image patterns and pathology reports. In this retrospective study, we reviewed all cases of endobronchial navigational bronchoscopy (ENB) performed using the nCLE system as a guide for injecting a dye marker or for biopsy of a lung nodule. All surgeries were performed at the Thoracic Surgery Department, University Hospital Nancy, France, between June and October 2023. All navigation procedures were performed under general anesthesia by a senior resident supervised by a senior surgeon, and endobronchial positioning assistance was provided by using the nCLE probe. A total of 30 patients were included in this study. The median size of the suspicious lesions was 16 mm [interquartile range (IQR), 13 mm]. The average time the nCLE system was in contact with the lesion was 5 minutes (IQR, 5 minutes). In 22/30 patients, dark, enlarged pleomorphic cells were visualized, and for one patient, a mix of dark clusters and dark enlarged pleomorphic cells was visualized, leading to a diagnosis of cancer in 22/23 patients (95.6%). For five patients, dark clusters were visualized, resulting in a diagnosis of cancer in 100% of patients. Pathology was performed for 6/30 patients/21 (20%) by endobronchial biopsy and for 24 patients by surgical resection of the suspicious lesion (80%). By retrospectively analyzing the nCLE lung cancer criteria published by Wijmans et al. in 2019, we observed 95.6% and 100% positive diagnoses according to the images visualized during the assistance of positioning. We believe that this type of technology could be used in the future for endobronchial analysis of suspected lesions and eventually for replacing frozen section analysis. However, the diagnostic value of this system needs to be confirmed, particularly for benign lesions.

STTAR: Surgical Tool Tracking Using Off-the-Shelf Augmented Reality Head-Mounted Displays.

The use of Augmented Reality (AR) for navigation purposes has shown beneficial in assisting physicians during the performance of surgical procedures. These applications commonly require knowing the pose of surgical tools and patients to provide visual information that surgeons can use during the performance of the task. Existing medical-grade tracking systems use infrared cameras placed inside the Operating Room (OR) to identify retro-reflective markers attached to objects of interest and compute their pose. Some commercially available AR Head-Mounted Displays (HMDs) use similar cameras for self-localization, hand tracking, and estimating the objects' depth. This work presents a framework that uses the built-in cameras of AR HMDs to enable accurate tracking of retro-reflective markers without the need to integrate any additional electronics into the HMD. The proposed framework can simultaneously track multiple tools without having previous knowledge of their geometry and only requires establishing a local network between the headset and a workstation. Our results show that the tracking and detection of the markers can be achieved with an accuracy of 0.09±0.06 mm on lateral translation, 0.42 ±0.32 mm on longitudinal translation and 0.80 ±0.39° for rotations around the vertical axis. Furthermore, to showcase the relevance of the proposed framework, we evaluate the system's performance in the context of surgical procedures. This use case was designed to replicate the scenarios of k-wire insertions in orthopedic procedures. For evaluation, seven surgeons were provided with visual navigation and asked to perform 24 injections using the proposed framework. A second study with ten participants served to investigate the capabilities of the framework in the context of more general scenarios. Results from these studies provided comparable accuracy to those reported in the literature for AR-based navigation procedures.

Bodily and Visual-Cognitive Navigation Aids to Enhance Spatial Recall in Mild Cognitive Impairment.

Individuals with mild cognitive impairment (MCI) syndrome often report navigation difficulties, accompanied by impairments in egocentric and allocentric spatial memory. However, studies have shown that both bodily (e.g., motor commands, proprioception, vestibular information) and visual-cognitive (e.g., maps, directional arrows, attentional markers) cues can support spatial memory in MCI. We aimed to assess navigation cues for innovative spatial training in aging. Fifteen MCI patients were recruited for this study. Their egocentric and allocentric memory recall performances were tested through a navigation task with five different virtual reality (VR) assistive encoding navigation procedures (bodily, vision only, interactive allocentric map, reduced executive load, free navigation without cues). Bodily condition consisted of an immersive VR setup to engage self-motion cues, vision only condition consisted of passive navigation without interaction, in the interactive allocentric map condition patients could use a bird-view map, in the reduced executive load condition directional cues and attentional markers were employed, and during free navigation no aid was implemented. Bodily condition improved spatial memory compared to vision only and free navigation without cues. In addition, the interactive allocentric map was superior to the free navigation without cues. Surprisingly, the reduced executive load was comparable to vison only condition. Moreover, a detrimental impact of free navigation was observed on allocentric memory across testing trials. These findings challenge the notion of an amodal representation of space in aging, suggesting that spatial maps can be influenced by the modality in which the environment was originally encoded.

The precision of drill calibration for dynamic navigation

ObjectivesTo quantify the reproducibility of the drill calibration process in dynamic navigation guided placement of dental implants and to identify the human factors that could affect the precision of this process in order to improve the overall implant placement accuracy. MethodsA set of six drills and four implants were calibrated by three operators following the standard calibration process of NaviDent® (ClaroNav Inc.). The reproducibility of the position of each tip of a drill or implant was calculated in relation to the pre-planned implants’ entry and apex positions. Intra- and inter-operator reliabilities were reported. The effects of the drill length and shape on the reproducibility of the calibration process were also investigated. The outcome measures for reproducibility were expressed in terms of variability range, average and maximum deviations from the mean distance. ResultsA satisfactory inter-rater reproducibility was noted. The precision of the calibration of the tip position in terms of variability range was between 0.3 and 3.7 mm. We noted a tendency towards a higher precision of the calibration process with longer drills. More calibration errors were observed when calibrating long zygomatic implants with non-locking adapters than with pointed drills. Flexible long-pointed drills had low calibration precision that was comparable to the non-flexible short-pointed drills. ConclusionThe clinicians should be aware of the calibration error associated with the dynamic navigation placement of dental and zygomatic implants. This should be taken in consideration especially for long implants, short drills, and long drills that have some degree of flexibility. Clinical significanceDynamic navigation procedures are associated with an inherent drill calibration error. The manual stability during the calibration process is crucial in minimising this error. In addition, the clinician must never ignore the prescribed accuracy checking procedures after each calibration process.

Autonomous Needle Navigation in Subretinal Injections via iOCT.

Subretinal injection is an effective method for direct delivery of therapeutic agents to treat prevalent subretinal diseases. Among the challenges for surgeons are physiological hand tremor, difficulty resolving single-micron scale depth perception, and lack of tactile feedback. The recent introduction of intraoperative Optical Coherence Tomography (iOCT) enables precise depth information during subretinal surgery. However, even when relying on iOCT, achieving the required micron-scale precision remains a significant surgical challenge. This work presents a robot-assisted workflow for high-precision autonomous needle navigation for subretinal injection. The workflow includes online registration between robot and iOCT coordinates; tool-tip localization in iOCT coordinates using a Convolutional Neural Network (CNN); and tool-tip planning and tracking system using real-time Model Predictive Control (MPC). The proposed workflow is validated using a silicone eye phantom and ex vivo porcine eyes. The experimental results demonstrate that the mean error to reach the user-defined target and the mean procedure duration are within an acceptable precision range. The proposed workflow achieves a 100% success rate for subretinal injection, while maintaining scleral forces at the scleral insertion point below 15mN throughout the navigation procedures.

Accuracy of Dental Implant Placement with Dynamic Navigation-Investigation of the Influence of Two Different Optical Reference Systems: A Randomized Clinical Trial.

This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6-3.9°) than group A, with a value of 6.3° (95% CI 4.0-8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92-2.78 mm) and 1.62 mm for workflow B (95% CI 1.2-2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.

Can We Leverage Text Analysis to Inform Policy Priorities Through a Community Engagement Grid?

The implementation of new performance-based navigation procedures at an East Coast airport in 2016 required the airport authority to step up its engagement with airport community residents. This case study leverages natural language processing to explain changes in the sentiments of airport community residents from 2015 to 2021. Natural language processing algorithms made it possible to create a community engagement grid that highlights issues identified in digital prints and social media and allows decision-makers to prioritize them based on awareness and urgency.

ETPNav: Evolving Topological Planning for Vision-Language Navigation in Continuous Environments.

Vision-language navigation is a task that requires an agent to follow instructions to navigate in environments. It becomes increasingly crucial in the field of embodied AI, with potential applications in autonomous navigation, search and rescue, and human-robot interaction. In this paper, we propose to address a more practical yet challenging counterpart setting - vision-language navigation in continuous environments (VLN-CE). To develop a robust VLN-CE agent, we propose a new navigation framework, ETPNav, which focuses on two critical skills: 1) the capability to abstract environments and generate long-range navigation plans, and 2) the ability of obstacle-avoiding control in continuous environments. ETPNav performs online topological mapping of environments by self-organizing predicted waypoints along a traversed path, without prior environmental experience. It privileges the agent to break down the navigation procedure into high-level planning and low-level control. Concurrently, ETPNav utilizes a transformer-based cross-modal planner to generate navigation plans based on topological maps and instructions. The plan is then performed through an obstacle-avoiding controller that leverages a trial-and-error heuristic to prevent navigation from getting stuck in obstacles. Experimental results demonstrate the effectiveness of the proposed method. ETPNav yields more than 10% and 20% improvements over prior state-of-the-art on R2R-CE and RxR-CE datasets, respectively. Our code is available at https://github.com/MarSaKi/ETPNav.

Image Processing Method of a Visual Communication System Based on Convolutional Neural Network

Unmanned motion platforms are being used in a wide range of industries. Unmanned motion platforms must have an autonomous and intelligent navigation procedure in order to carry out their system functions. Traditional inertial navigation and radio navigation have poor accuracy and autonomy when not dependent on satellite circumstances. The accuracy of image recognition algorithms must meet strict standards. This study and exploration of the high-precision scene image recognition system is based on convolutional neural network structure optimization. To demonstrate the viability of the approach, simulation experiments are carried out on the NUC dataset using the recognition technique based on a convolutional neural network that is proposed. The fundamental network architecture of a convolutional neural network is optimized using the L2 regularization technique. The experimental findings demonstrate that the NUC dataset now has better recognition accuracy. In terms of recognition accuracy, the suggested method satisfies the predetermined requirements.

2D/3D Deep Registration Along Trajectories With Spatiotemporal Context: Application to Prostate Biopsy Navigation.

The accuracy of biopsy targeting is a major issue for prostate cancer diagnosis and therapy. However, navigation to biopsy targets remains challenging due to the limitations of transrectal ultrasound (TRUS) guidance added to prostate motion issues. This article describes a rigid 2D/3D deep registration method, which provides a continuous tracking of the biopsy location w.r.t the prostate for enhanced navigation. A spatiotemporal registration network (SpT-Net) is proposed to localize the live 2D US image relatively to a previously aquired US reference volume. The temporal context relies on prior trajectory information based on previous registration results and probe tracking. Different forms of spatial context were compared through inputs (local, partial or global) or using an additional spatial penalty term. The proposed 3D CNN architecture with all combinations of spatial and temporal context was evaluated in an ablation study. For providing a realistic clinical validation, a cumulative error was computed through series of registrations along trajectories, simulating a complete clinical navigation procedure. We also proposed two dataset generation processes with increasing levels of registration complexity and clinical realism. The experiments show that a model using local spatial information combined with temporal information performs better than more complex spatiotemporal combination. The best proposed model demonstrates robust real-time 2D/3D US cumulated registration performance on trajectories. Those results respect clinical requirements, application feasibility, and they outperform similar state-of-the-art methods. Our approach seems promising for clinical prostate biopsy navigation assistance or other US image-guided procedure.

Performance-Based Navigation Approach Procedures with Barometric Vertical Guidance: How to Select the Air Temperature for Approach Procedure Design

In performance-based navigation (PBN) procedures with barometric vertical guidance, the effective vertical path angle (VPA) depends on the actual air temperature at the time of approach execution. A very low design temperature could result in an obstacle clearance height (OCH) higher than needed; hence, the airport throughput could be reduced when the cloud ceiling is below the OCH. Conversely, the design of a low temperature higher than is practical could lead to long periods in which the procedure cannot be used. The results of this research show that there is not much difference between the effective VPA for the different low temperatures studied. However, this slight difference, when obstacles penetrating the final approach surface (FAS) exist, usually leads to the approach minima being significantly different from each other. The objective of this study was to analyse the impact of the selected designed low temperatures in PBN procedures with barometric vertical guidance on the OCH/runway throughput and approach periods of use balance. Finally, guidelines on the selection of the minimum designed low temperature are proposed.

Efficacy of indocyanine green systemic administration for bile leak detection after hepatectomy: a protocol for a prospective single-arm clinical trial with a historical control group

IntroductionBile leakage (BL) after hepatectomy cannot always be detected with conventional methods; moreover, BL cannot be completely prevented. Recently, navigation procedures with indocyanine green (ICG) have been reported. Furthermore, we...

The additional diagnostic value of virtual bronchoscopy navigation in patients with pulmonary nodules – The NAVIGATOR study

BackgroundThe number of solitary pulmonary nodules to be evaluated is expected to increase and therefore we need to improve diagnostic and therapeutic tools to approach these nodules. To prevent patients from futile invasive procedures and receiving treatment without histological confirmation of cancer, we evaluated the value of virtual bronchoscopy navigation to obtain a diagnosis of the solitary pulmonary nodule in a real-world clinical setting. MethodsIn the NAVIGATOR single center, prospective, observational cohort study patients underwent a virtual bronchoscopy navigation procedure with or without guide sheet tunnelling to assess a solitary pulmonary nodule. Nodules were considered not accessible if a diagnosis could not be obtained by either by CT-guided transthoracic biopsy or conventional bronchoscopy. ResultsBetween February 2021 and January 2022 35 patients underwent the virtual bronchoscopy navigation procedure. The overall diagnostic yield was 77% and was dependent on size of the nodule and chosen path, with highest yield in lesions with an airway path. Adverse events were few and manageable. ConclusionVirtual bronchoscopy navigation with or without sheet tunnelling is a new technique with a good diagnostic yield, also in patients in whom previously performed procedures failed to establish a diagnosis and/or alternative procedures are considered not feasible based on expected yield and/or safety. Preventing futile or more invasive procedures like surgery or transthoracic punctures with a higher complication rate is beneficial for patients, and allowed treatment adaptation in two-third of the analyzed patient population.

Case report: multiple lesions during navigation bronchoscopy; seen one, seen them all?

Peripheral pulmonary nodules are often detected as multiple nodules in one patient. Computed tomography (CT) guided transthoracic biopsy (TTNB) is the most widely implemented method for minimal invasive biopsy of pulmonary nodules, but generally only one nodule is sampled per procedure. Navigation bronchoscopy is an endobronchial procedure with very low complication rates, and uses high-end image guidance which allows for the sampling of multiple nodules in one session, while also allowing inspection of the central airways and endobronchial ultrasound (EBUS) guided staging in one session. This report presents a unique case with three different synchronous primary tumors treated with three different treatment modalities that highlights the added value of cone-beam CT guided navigation bronchoscopy (CBCT-NB) in the diagnostic work-up of suspected early-stage lung cancer. This case describes an asymptomatic patient with no history of prior lung cancer referred because of a shadow seen on a screening X-ray. CT and positron emission tomography (PET) showed two nodules for which a navigation procedure was performed. Both nodules were sampled, and on inspection, a third occult endobronchial lesion was also found. Pathology revealed three separate primary tumors, which were treated with three different treatment modalities: surgery, radiotherapy and endobronchial cryoablation. Current follow-up at 12 months shows no signs of recurrence. This case highlights that synchronous primary malignancies do occur and require a patient tailored approach to minimize treatment related morbidity and optimize survival. To this goal, image guided navigation bronchoscopy allows for a full and complete diagnostic evaluation and can be combined with a staging EBUS in one single session.

ELECTRONIC CHARTS: DEVELOPMENT OF THE MULTIPURPOSE MODEL FOR CROSS TRACK LIMIT DETERMINATION

According to the requirements of the International Convention for the Safety of Life at Sea (SOLAS-74) vessels must be equipped with Electronic Chart Display and Information System (ECDIS). This equipment is designed to improve safety of navigation and definitely has a number of indisputable advantages over the paper charts navigation. At the same time use of ECDIS requires navigators to have a sufficient level of competency for professional operation. Inadequate setting of safety parameters as well as incorrect interpretation of information from the display can lead to an accident. The determination of cross track limit (XTL) value as one of the route safety parameters in ECDIS is considered in the paper. Some companies navigational procedures are studied; it has been found out that companies have individual requirements regarding XTL value and they can vary. The issue of XTL value determination was recently studied and the authors of the previous research had proposed their own method of XTL calculation. This method is analysed in the paper and it has been concluded that this method is applicable for determining minimum XTL value, however in order to find the optimal value it is necessary to consider ship particulars and characteristics of a specific waterway as well as company requirements for under-keel clearance. The model structure, which integrates this information, is proposed in the paper, and the previously proposed method is used within the model. The model developed by the author is flexible: the input values can be adjusted, which allows to assess the safety of any size ship passage through any waterway. The incorporation of bottom contour information into the model through a piecewise function enables to assess the under-keel clearance for any values of XTL and to determine dangerous values of cross-track distance in particular conditions. The main disadvantage of the model is a necessity to define the piecewise function which adequately corresponds with the actual depth distribution in the waterway analysed, which restricts the application of this model to natural waterways with a difficult terrain of the bottom. It should be noted that with particular input values some «borderline cases» can take place, when the safety of passage is doubtful. In order to solve these uncertainties, the model can be later upgraded by including experts’ opinions with the use of fuzzy logic methods.

Minimizing magnetic resonance image geometric distortion at 7 Tesla for frameless presurgical planning using skin-adhered fiducials.

7T MRI offers significant benefits to spatial and contrast resolution compared to lower field strengths. This superior image quality can help better delineate targets in stereotactic neurosurgical procedures; however, the potential for increased geometric distortions at 7T has impaired its widespread use for these applications. Image geometric distortions can be due to distortions of B0 arising from tissue magnetic susceptibility effects or inherent field inhomogeneities, and nonlinearity of the magnetic field gradients. The purpose of this study was to investigate the use of 7T MRI for neurosurgical frameless stereotactic navigation procedures. Image geometric distortions at the skin surface in 7T images were minimized and compared to results from clinical 3T frameless imaging protocols. A 3D-printed grid phantom filled with oil was designed to perform a fine calibration of the 7T imaging gradients, and an oil-filled head phantom with internal targets was used to determine ground truth (from computed tomography [CT]) positioning errors. Three volunteers and the head phantom were imaged consecutively at 3T and 7T. Ten skin-adhesive fiducial markers were placed on each subject's exposed skin surface at standard clinical placement locations for frameless procedures. Imaging sequences included MPRAGE (three bandwidths at 7T: 400, 690, and 1020Hz/pixel, and one at 3T: 400Hz/pixel), T2 SPACE, and T2 SPACE FLAIR acquisitions. An additional GRE field map was acquired on both scanners using a multi-echo GRE sequence. Custom Matlab code was used to perform additional distortion correction of the images using the unwrapped field maps. Fiducial localization was performed with 3D Slicer, with absolute fiducial positioning errors determined in phantom experiments following rigid registration to the CT images. For human experiments, 3T and 7T images were registered and relative differences in fiducial locations were compared using two-tailed paired t-tests. Phantom measurements at 7T yielded gradient distance scaling errors of 1.1%, 2.2%, and 1.0% along the x-, y-, and z-axes, respectively. These system miscalibrations were traced back to phantom manufacturing deviations in the sphericity of the vendor's gradient calibration phantom. Correction factors along each gradient axis were applied, and afterward, geometric distortions of less than 1mm were obtained in the 7T MR head phantom images for the 1020Hz/pixel bandwidth MPRAGE sequence. For the human subjects, four fiducial locations were excluded from the analysis due to patient positioning differences. Differences between 3T and 7T MPRAGE with low/medium/high bandwidth were 2.2/2.6/2.3mm, respectively, before the correction, reducing to 1.6/1.3/1.0mm after the correction (p<0.001). T2 SPACE and T2 SPACE FLAIR yielded a similar pattern when the correction was applied, decreasing from 2.1 to 0.8mm, and 2.6 to 1.0mm, respectively. 7T MRI can be used to perform frameless presurgical planning with skin-adhesive fiducials. Geometric distortions can be reduced to a clinically relevant level (errors<∼1mm) with no significant susceptibility-related distortions, by using high receiver bandwidth, ensuring gradients are properly calibrated, and placing skin fiducials in areas where distortions from patient positioning are minimal.

Unified Navigational Approach for an Autonomous Vehicle Joining a Multilane Highway from Ramp

Navigating an autonomous vehicle through a circular ramp to join a multilane highway having high-density traffic is a very challenging task. Occupant and vehicle safety are the major considerations while establishing merging scenarios. This article proposes and experimentally implements safe and tactical navigational procedures for merging and leaving the highway scenario using the rendezvous guidance (RG) technique and its modified form. Test scenarios have been established for navigating AVs to merge and leave the highway on a multilane highway with or without the presence of any other vehicle in the zone. In addition, the navigation with enhanced performance of the modified RG algorithm is also established and compared to the conventional RG algorithm. The results indicate that time is reduced considerably by using the modified RG technique. The experimental and simulation results are compared, and their results are the same.

URGENSI KESELAMATAN NAVIGASI PADA PENGANGKUTAN KOMODITAS DI JALUR PELAYARAN DI KAWASAN ASIA-PASIFIK

This research aims to analyze the urgency of safety navigation procedures which play an important role in ensuring the safety of life at sea. Then, the author also analyzes the components of safety navigation procedures that have important role in the shipping sector in the Asia-Pacific Region. Where the level of intensity of shipping and international trade in the area is very high. This is normative research with a perspective using primary and secondary legal materials. The technique of collecting legal materials is a literature study which is equipped with a deduction technique to analyze the material. The results show that there are twelve navigation safety procedures that play an important role in ensuring the safety of life at sea. Where navigation safety procedures need to be understood, regulated, and further improved to improve efficiency, security and shipping safety. Therefore, navigational safety plays a very vital role in the field of transporting commodities at sea, especially in shipping lanes in the Asia-Pacific Region.

DRL-RNP: Deep Reinforcement Learning-Based Optimized RNP Flight Procedure Execution.

The required navigation performance (RNP) procedure is one of the two basic navigation specifications for the performance-based navigation (PBN) procedure as proposed by the International Civil Aviation Organization (ICAO) through an integration of the global navigation infrastructures to improve the utilization efficiency of airspace and reduce flight delays and the dependence on ground navigation facilities. The approach stage is one of the most important and difficult stages in the whole flying. In this study, we proposed deep reinforcement learning (DRL)-based RNP procedure execution, DRL-RNP. By conducting an RNP approach procedure, the DRL algorithm was implemented, using a fixed-wing aircraft to explore a path of minimum fuel consumption with reward under windy conditions in compliance with the RNP safety specifications. The experimental results have demonstrated that the six degrees of freedom aircraft controlled by the DRL algorithm can successfully complete the RNP procedure whilst meeting the safety specifications for protection areas and obstruction clearance altitude in the whole procedure. In addition, the potential path with minimum fuel consumption can be explored effectively. Hence, the DRL method can be used not only to implement the RNP procedure with a simulated aircraft but also to help the verification and evaluation of the RNP procedure.

Does navigation still have avalue in trauma surgery?

Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing. There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine. To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation. Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high.